Inflammatory Bowel Disease Flashcards
What is more prevalent, UC or Crohn’s?
Both have equal prevalence
What tends to appear later on in life, UC or Crohn’s?
UC - 30’s
Crohn’s - 20’s
What does smoking increase the risk of, UC or Crohn’s?
Crohn’s
Protective in UC
Which is TH2-mediated, UC or Crohn’s?
UC
Crohn’s is TH1/TH17-mediated
Backwash ileitis occurs in which condition, UC or Crohn’s?
UC
Which commonly is associated with strictures, UC or Crohn’s?
Crohn’s
Which condition affects the mucosa and forms crypt abscesses, UC or Crohn’s?
UC
Crohn’s = transmural inflammation
Which condition has a cobblestone mucosa (when describing ulceration), UC or Crohn’s?
Crohn’s
In which condition can you get granulomas, UC or Crohn’s?
Crohn’s
In which condition can fistulas occur, UC or Crohn’s?
Crohn’s
Which condition typically presents with bloody diarrhoea + mucus, UC or Crohn’s?
UC
Which condition do you get faecal urgency and tenesmus, UC or Crohn’s?
UC
What size does the colon have to be before it can be called a toxic megacolon?
> 6cm
Name the three skin signs in IBD
Clubbing Erythema nodosum Pyoderma gangrenosum (esp UC)
Name the three eye signs in IBD
Iritis
Episcleritis
Conjunctivitis
Name the three joint signs in IBD
Arthritis (non-deforming, assymetrical)
Sacroiliitis
Ank Spond
Name the three HPB signs in IBD
Primary sclerosing cholangitis + cholangiocarcinoma (esp. UC)
Gallstones (esp crohns)
Fatty liver
Which do you have a higher risk of colorectal cancer, UC or Crohn’s?
UC - 15%
What are abdominal and anorectal abscesses more common in, UC or Crohn’s?
Crohn’s
What is malabsorption more common in, UC or Crohn’s?
Crohn’s
Fat = steatorrhoea, gallstones
B12 = megaloblastic anaemia
Vit D = Osteomalacia
Protein = oedema
What bloods would you run to investigate UC? (4)
FBC: drop in Hb, raised WCC
LFT: drop in albumin
CRP/ESR raised
Blood Cultures
What stool sample tests would you run in UC and Crohns? (2)
M, C and S (Microscopy, culture and sensitivity): exclude campy, shigella, salmonella
CDT (C. diff toxin)
What imaging would you order for UC? (2 main, 2 special)
ABX: megacolon, wall thickening
CXR: perf
CT
Barium/gastrograffin enema (lead piping=no haustra, thumbprinting=muscosal thickening, pseudopolyps=regenerating mucosal island
What is the criteria used to assess the severity of UC?
Truelove and Witts
Mild, moderate, severe
What does the Truelove and Witts criteria take into account? (6)
Motions PR bleed Temp HR Hb ESR
What is the management of acute UC?
NBM IV hydration Hydrocortisone IV 100mg QDS + PR transfuse if required Thromboprophylaxis: LMWH
RCT’s show no benefit of ABx
What are the four acute complications of UC
Perf
Haemorrhage
Toxic megacolon
VTE
What therapy do you use if you see an improvement after an acute episode of UC or Crohns?
Oral prednisolone
What therapy do you use if you see a regression after an acute episode of UC?
Surgical: ?Colectomy
Medical: ciclosporin, infliximab
In mild to moderate UC, what oral therapies are used?
Mesalazine
Prednisolone 2nd line
Infliximab 3rd line
What percentage of UC sufferers require emergency surgery at some stage?
20%
What bloods would you run to investigate crohns? (5)
FBC: drop in Hb, raised WCC LFT: drop in albumin CRP/ESR raised Blood Cultures Haematinics: Fe, B12, Folate
What imaging would you request in Crohns (2 basic, 2 special)
AXR: obstruction, sacroiliitis
CXR: perf
MRI: pelvic disease + fistulas
Small bowel follow through: skip lesions, rose-thorn ulcers, cobblestoning, string sign of Kantor (narrow terminal ileum - little bit of contrast allowed through, looks like string)
What is cobblestoning?
Ulceration and mural oedema
What 6 parameters indicate a severe attack?
raised temp, HR, ESR, CRP, WCC
drop in albumin
Mx of severe attack of crohns?
NBM, IV hydration Hydrocortisone IV + PR if rectal disease Metronidazole Thromboprophylaxis: LMWH Dietician review
What is the difference in acute management between UC and Crohns?
You don’t use Abx in UC
What are the two supportive treatments for crohns?
High fibre diet
vitamin supplements
What is 1st line medical therapy for crohns affecting:
1) ileocaecal region
2) colonic region
1) budesonide
2) sulfasalazine
What is second line medical therapy for crohns
prednisolone
3rd-methotrexate
4th-infliximab